The presence of hypertension and atrial fibrillation has a statistically significant association with the diagnosis of cerebrovascular accidents (CVA) in patients with systemic sclerosis (SSc), according to study results published in the Open Journal of Rheumatology and Autoimmune Diseases.1

Cerebrovascular accidents, which can be categorized as either ischemic or hemorrhagic, are major causes of death and morbidity, globally. Approximately 80% of all CVAs are ischemic, characterized by some form of vessel occlusion.2 Previous studies have suggested a possible link between SSc and CVA macrovascular complications, including stroke.

In this study, the researchers aimed to describe the clinical characteristics of patients with a diagnosis of SSc who later experienced a stroke, and also to identify the association between SSc and stroke.

Of the patients with SSc treated at the University of Pennsylvania Health System, the researchers assessed data from those who experienced a CVA, using the ICD10 coding system. Information regarding demographics and CVA risk factors were collected from the charts of patients with a diagnosis of both SSc and CVA and compared with a control group of randomly selected patients with SSc who never experienced a CVA. Statistical analysis included continuous variables, 2-sample t-test and 2-tailed Fischer’s exact test.


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Among the total cohort of 2080 patients with SSc who were actively followed up, 36 (1.7%) were diagnosed with a CVA after their diagnosis of SSc; 36 patients were randomly selected to be in the control group.

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Results showed that hypertension and atrial fibrillation were more frequently observed and statistically significant in patients with SSc who experienced a CVA vs those who did not (n=28 vs 17 and 9 vs 2; P =.014 and P =.046, respectively). Comorbidities including hyperlipidemia, diabetes, tobacco use, family history of CVA, and carotid artery disease were also more commonly seen among patients with SSc and CVA vs no CVA, though the difference between the 2 groups was not statistically significant. Researchers also conducted subgroup analysis based on SSc type.

Study limitations included the small sample size and the possibility of selection bias from studying a population from a single, university-based hospital.

“This provides additional evidence to our understanding of risk factors contributing to morbidity in SSc. Future, larger studies are needed to further characterize these relationships in order to provide even more valuable information to physicians treating patients with SSc,” the researchers concluded.

References

1. Inserra CJ, Derk CT. Predictors of a cerebrovascular accident in a population of systemic sclerosis patients followed at a large academic center with a dedicated scleroderma center. Open J Rheumatol Autoimmune Dis. 2020;10:45-56.

2. Thrift AG, Dewey HM, Macdonell RA, McNeil JJ, Donnan GA. Incidence of the major stroke subtypes: initial findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 2001;32(8):1732-1738.